Healthcare Provider Details

I. General information

NPI: 1144733767
Provider Name (Legal Business Name): JILLIAN BRYNN GOLDNEY FNP-C, DCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14800 W MOUNTAIN VIEW BLVD STE 160
SURPRISE AZ
85374-2700
US

IV. Provider business mailing address

14800 W MOUNTAIN VIEW BLVD STE 160
SURPRISE AZ
85374-2700
US

V. Phone/Fax

Practice location:
  • Phone: 623-584-3376
  • Fax: 623-584-3375
Mailing address:
  • Phone: 623-584-3356
  • Fax: 623-584-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP10743
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: